Complication rates in the clinical practice of long-term use central venous catheters in cancer patients

Abstract

Background. The use of indwelling long term  central venous catheters (CVC) has improved the management of cancer patients. However, this device might cause morbidity and lead to a great number of central venous catheter-related thrombosis (CRT). Medical consequences include catheter dysfunction and pulmonary embolism. Vessel injury caused by the procedure of CVC insertion is the most important risk factor for development of CRT. In this retrospective study, we analyzed the incidence and complications of long term use of CVC in adult patients with cancer. Methods. We examined the data about the CVC inserted in our institution during an 8-year period. A single type of port-a-cath was used: BardPort (Bard Access System, Salt Lake City, USA). Two-hundred and ten CVC were placed in 197 consecutive unselected patients; 12 pts received a second device, 1 pt a third one (mean age 63 yrs, range 37-83; Male: Female ratio 123: 74). The follow-up continued until CVC was removed or the patient died. Results. 92 CVC were removed, 79 pts died with CVC in situ; 39 pts are still alive carrying CVC. Over 60978 pt-days of follow-up (mean 310±329, range 1-1752) 37 out of 197 pts (18.8%) showed complications in 37 of 210 CVC (17.6% and 0.61 episodes per 1000 catheter days of use). 12 pts (6%) removed CVC for complications, 2 for sepsis and the other ones for catheter-related thrombosis; 9 pts (4.5%) changed the treatment plan, 1 for sepsis and 8 for CRT. The mean time of CRT was 125±158 days (range 14-746 days). All pts with CRT were treated with anticoagulants, 4 pts underwent thrombolisis treatment, 8 pts needed removal of CVC. 4 port-a-caths reported bacteraemia (1.9% of devices) (0.06 episodes per 1000 catheter days of use). Furthermore only 1 complication (0.5%) life-threatening was reported. Conclusions. We observed that the incidence of CRT is the most frequent complication and it may change the treatment plan in few cases (4%). The efficacy and safety of pharmacologic prophylaxis for CVC related thrombosis is not established and the last recommendations suggest that clinicians do not routinely use prophylaxis to try to prevent thrombosis related to long-term indwelling CVCs in cancer patients. Additional studies performed in high risk populations with appropriate dosage and timing will help to define which patients could benefit from this prophylaxis.